Mortazavi Seyed Hossein, Motamedi Mohammad Hosein Kalantar, Navi Fina, Pourshahab Majid, Bayanzadeh Seyed Masoud, Hajmiragha Habib, Isapour Mona
Department of Oral and Maxillofacial Surgery, Taleghani Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
Natl J Maxillofac Surg. 2010 Jul;1(2):108-11. doi: 10.4103/0975-5950.79210.
The first step in the management of Temporomandibular Disorders (TMD) is usually noninvasive, especially if the disorder is in the early stages. Clinically, pain and clicking are early signs and symptoms of TMD. The management of TMD usually includes "splint therapy" and analgesics. In this study, we report our long-term outcomes in the treatment of patients suffering from early TMD.
We assessed the records of 138 patients who were referred for management of TMD. Selection was based on pain and/or clicking of the Temporomandibular Joint (TMJ), no pathologic lesions of the TMJ, no anterior disc displacement without reduction (closed lock), no Degenerative Joint Disease, no history of migraine, trauma, osteoarthritis, metabolic disease, or malocclusion (deep bite, cross bite, jaw deformity, etc). The patients were treated with an acrylic maxillary Interocclusal Splint (IOS) cuspid-rise type and were told to refrain from biting, yawning and chewing hard food. The outcome of the treatment, potential etiologic factors (Bruxism), signs and symptoms and patient demographics (such as age, sex, treatment duration, etc.) were assessed. The data were analyzed using the Chi-square test to correlate significance.
One hundred thirty-eight patients (26 males and 112 females) with early signs and symptoms of TMD (pain and/or click of the TMJ) were treated from 2001 to 2010; 81% were females and 19% were males. All the 138 patients used the IOS at night only. The patients were followed-up for 1-9 years. Data analysis showed that 64% of the patients were completely relieved of signs and symptoms; 22% were moderately relieved (decreased severity of signs and symptoms) and 14% had no noticeable post-treatment changes in clicking or pain (P = 0.001). Patients with bruxism and those presenting with both pain and clicking showed a better response to IOS treatment (P = 0.046 and P = 0.001, respectively). The results also showed that age, sex, severity of symptoms and duration of the treatment did not influence treatment results in this group of patients with early TMD.
In this population, TMD was significantly higher in females. Treatment of early TMD with IOS was effective and moderately effective in long-term in over 80% of the patients during the follow-up period of 1-9 years. Bruxism had a significant etiologic role in TMD; occlusal attrition of the dentition, pain of all the teeth, early morning pain of the masticatory muscles and the TMJ are signs and symptoms to suspect nocturnal bruxism. Use of an IOS is recommended to prevent potential damage to the dentition, periodontium and the TMJ in early TMD.
颞下颌关节紊乱病（TMD）管理的第一步通常是非侵入性的，特别是在疾病早期阶段。临床上，疼痛和弹响是TMD的早期体征和症状。TMD的管理通常包括“咬合板治疗”和镇痛药。在本研究中，我们报告了早期TMD患者治疗的长期结果。
我们评估了138例因TMD前来就诊患者的记录。入选标准基于颞下颌关节（TMJ）疼痛和/或弹响、TMJ无病理病变、无前移位不可复性盘前移位（闭口绞锁）、无退行性关节病、无偏头痛、创伤、骨关节炎、代谢疾病或错牙合（深覆牙合、反牙合、颌骨畸形等）病史。患者接受丙烯酸类上颌间牙合垫（IOS）尖牙升高型治疗，并被告知避免咬、打哈欠和咀嚼硬食。评估治疗结果、潜在病因（磨牙症）、体征和症状以及患者人口统计学特征（如年龄、性别、治疗持续时间等）。使用卡方检验分析数据以关联显著性。
2001年至2010年期间，对138例有TMD早期体征和症状（TMJ疼痛和/或弹响）的患者进行了治疗；其中81%为女性，19%为男性。所有138例患者仅在夜间使用IOS。患者随访1至9年。数据分析显示，64%的患者体征和症状完全缓解；22%中度缓解（体征和症状严重程度降低），14%在治疗后弹响或疼痛无明显变化（P = 0.001）。磨牙症患者以及同时出现疼痛和弹响的患者对IOS治疗反应更好（分别为P = 0.046和P = 0.001）。结果还表明，年龄、性别、症状严重程度和治疗持续时间对这组早期TMD患者的治疗结果无影响。
在该人群中，女性TMD发生率显著更高。在1至9年的随访期内，用IOS治疗早期TMD对超过80%的患者长期有效和中度有效。磨牙症在TMD中具有重要病因学作用；牙列咬合磨损、全口牙齿疼痛、咀嚼肌和TMJ晨痛是怀疑夜间磨牙症的体征和症状。建议使用IOS预防早期TMD对牙列、牙周组织和TMJ的潜在损害。
